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The key distinction lies in a single hydrogen and oxygen atom oriented oppositely on each molecule, as depicted in red in the figure below

FDA approves Lillys Mounjaro TM (tirzepatide) injection, the first and only GIP and GLP-1 receptor agonist for the treatment of adults with type 2 diabetes | Eli Lilly and Company Oral tirzepatide (Zepbound active ingredient), prescribed Henry Meds FDA Approves Trulicity

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It is not as effective as surgery but is sometimes the only choice for people who cannot have a general anesthetic